Salis Care C.I.C.

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. This is the first assessment for this service. This key question has been rated requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to the management oversight of the service and the failure to ensure records were up to date and relevant to the support people were receiving.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities. The management team at Salis care had identified changes and improvements to the support people received were needed. However, no overall strategy of the desired outcomes had been implemented, and no cohesive plan had been developed as to how these outcomes would be met. This meant the quality of people’s lives and the opportunities available were not consistently monitored to ensure the service developed in a personalised way.

The management team spoke warmly about what they wanted for people, and this was shared by staff. Staff expressed they wanted people to be happy, safe and calm and this was evident in the way they interacted with people. However, further skills development and direction was required to ensure a culture of highly personalised care where people’s needs and aspirations were at the centre of their support.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively. Since registration with the Care Quality Commission the provider’s management team had changed in its entirety. Relatives told us these changes had been difficult as they were not always kept up to date with what was happening. One relative told us, “At times it has been hard to know who to trust with all the changes.” Staff members also told us that whilst they felt the new management team had made improvements, changes to systems impacting their roles were not always clear. The manager consistently referred to the different management structures as ‘Salis 1’ and ‘Salis 2’ to reflect the change in leadership. Whilst this was designed to ensure there was a difference between the two management structures, this also raised concerns regarding the on-going accountability of the provider as a whole. This had led to a disjointed approach to making improvements to the support people received and meant staff did not always have the guidance they required.

The leadership team all spoke about the care they wished people to receive with enthusiasm and compassion. They shared presentations developed to inform with the local authority about the changes and improvements being made. However, the lack of planning and consistency in implementing these improvements did not always ensure changes were made in an effective and timely way.

People did not always feel they could speak up and that their voice would be heard. Relatives told us that whilst they felt the management team listened to their concerns, they did not always feel action was taken promptly. One relative told us, “I will always say if I can see things need to change. It’s about my [relative] so I wouldn’t keep quiet. They’ve listened and arranged meetings, but we don’t always see the changes.” They went on to describe they understood that some of the issues would take time to put right as their relatives needed to rebuild skills. The management team confirmed they had met with relatives or tried to set up meetings and records confirmed this. Where discussions had taken place they told us they were working with professionals to ensure they had the resources needed to implement changes discussed effectively.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. Staff told us they felt treated fairly and felt they would be able to speak with the management team if they had concerns in relation to this. One staff member told us, “The manager is respectful and easy to talk to. We can raise any problems.” The provider had a policy in relation to equality, diversity and inclusion which provided guidance for both the staff and leadership team.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. Robust quality assurance processes had not been implemented in order to monitor the support people received and the systems in place. No audits of care plans, risk assessments, daily records or Mental Capacity Act processes had been completed. This meant the provider did not have a system to monitor the support people received or the impact this had on their quality of life.

Where audits were completed this had led to improvements and minimised risks. Medicines were regularly audited and where appropriate, weekly checks of the support people received with their finance made. This had led to a significant reduction in errors and additional safeguards being implemented. However, the medicines audit had failed to identify concerns with the level of detail contained within PRN protocols.

Care records did not reflect the support people required. The manager told us they were aware there had been many changes to the way people were supported without their care records being updated. They told us they were waiting for support from other professionals involved in people’s care to support them in making these changes. This meant they had failed to ensure accurate records and guidance for staff were maintained.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement. The new management team had come into post due to significant concerns being raised regarding the quality and safety of the care people were receiving. They had worked alongside the local authority to make changes and implement safe systems of working in areas including people’s finances and medicines. Whilst many of the changes had been positive for people, professionals supporting the service told us there could be difficulties in communicating with the management team at times. One professional told us, “Things are improving but it can be hard to get a full picture and get to the bottom of things.” The leadership team told us they would continue to liaise with all professionals and discuss what additional information could be shared to ensure effective communication.

The management team did not always demonstrate a good knowledge of how their responsibilities linked with the responsibilities of other professionals. This included the belief that other professionals would take responsibility for writing support plans and risk assessments. In other areas we found there was positive partnership working such as discussions from the speech and language therapy team regarding how to support someone safely.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. The provider did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. The provider had not developed an action plan to identify, plan and monitor the improvements needed across the service. Whilst improvements could be seen in the support people received and the systems in place, there was no holistic approach focussed on improving all aspects of people’s lives. The manager and director of care told us they had prioritised risks such as medication, financial support and overly restrictive practices when making decisions regarding improvement areas. Whilst we observed improvements had been made in these areas, the lack of planning and monitoring meant should the systems not work effectively risks would not continually be identified.

Following our inspection the provider informed us of further changes in the management team. The provider indicated these had been made to ensure there was a more structured, quality focussed approach to the improvements required within the service.